Key result
Molecular surveillance in Germany in 2015 identified a new recombinant variant of Enterovirus A71 subgenogroup C1 among hospitalized patients, predominantly children under 5 years of age, with severe neurologic symptoms.
A new recombinant EV-A71 subgenogroup C1 strain was identified in Germany in 2015, highlighting the need for ongoing molecular surveillance of enteroviruses.
Alerts clinicians to neurovirulence risk in young children with enteroviral illness; leaves open needs for global surveillance and vaccine impact studies.
To the Editor: Enterovirus A71 (EV-A71) strains circulate worldwide, and numerous outbreaks have been reported from Asia, Australia, Europe, and America (1). Symptomatic infections range from mild febrile illness or characteristic diseases such as hand, foot and mouth disease to severe neurologic disorders such as meningitis/encephalitis and acute flaccid paralysis. EV-A71 infections are usually asymptomatic and self-limiting but can also result in life-threatening complications such as pulmonary edema and cause death, predominantly in children <5 years of age. On the basis of viral protein 1 (VP1) sequences, 3 genogroups (A, B, C), including different subgenogroups (B0–B5, C1–C5), have been defined (2,3). Additional genogroups (D, E, F, G) have been proposed (4,5). In Europe, C1 and C2 strains have circulated predominantly within the past 2 decades, and recent introduction of C4 strains has been reported (6,7). Within subgenogroup C1, a lineage is replaced by the subsequent lineage over time (8).
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Böttcher et al. (2016) conducted a letter in Enterovirus infection with suspected meningitis/encephalitis or acute flaccid paralysis (n=419). Enterovirus A71 subgenogroup C1 was evaluated on Detection and molecular characterization of Enterovirus A71 strains. Molecular surveillance in Germany in 2015 identified a new recombinant variant of Enterovirus A71 subgenogroup C1 among hospitalized patients, predominantly children under 5 years of age, with severe neurologic symptoms.